Skip to main content

Imaging of the Pathology of the Vertebral Arteries

  • Reference work entry
  • First Online:
Neurovascular Imaging
  • 3291 Accesses

Abstract

The vertebral arteries are among the most clinically important arteries in the body, providing blood flow to the posterior circulation of the brain. Both radiologists and clinicians need to understand the basic anatomy and the pathology that can affect the vertebral arteries in the acute and non-acute settings. Radiologists, in particular, need to be cognizant of the imaging findings of vertebral artery pathology as misdiagnosis of certain common conditions could be potentially disastrous. In this chapter, the embryology and anatomy of the vertebral arteries is reviewed, with a focus on normal variants and vascular territories. Vertebral artery diseases are then discussed, including atherosclerotic disease, vertebral artery dissection, subclavian steal syndrome, and a variety of other conditions. Each section is organized by epidemiology and clinical findings, pathophysiology, imaging findings, and work-up and management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 699.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 999.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Okahara M, Kiyosue H, Mori H, Tanoue S, Sainou M, Nagatomi H (2002) Anatomic variations of the cerebral arteries and their embryology: a pictorial review. Eur Radiol 12(10):2548–2561. doi:10.1007/s00330-001-1286-x

    Article  PubMed  Google Scholar 

  2. Dimmick SJ, Faulder KC (2009) Normal variants of the cerebral circulation at multidetector CT angiography. Radiographics 29(4):1027–1043. doi:10.1148/rg.294085730

    Article  PubMed  Google Scholar 

  3. Luh GY, Dean BL, Tomsick TA, Wallace RC (1999) The persistent fetal carotid-vertebrobasilar anastomoses. AJR Am J Roentgenol 172(5):1427–1432. doi:10.2214/ajr.172.5.10227532

    Article  CAS  PubMed  Google Scholar 

  4. Osborn AG, Salzman KL, Barkovich AJ (2009) Diagnostic imaging. Brain, 2nd edn. Amirsys, Salt Lake City

    Google Scholar 

  5. Osborn AG, Jacobs JM, Osborn AG, Ralph Erskine Conrad Memorial Fund (1999) Diagnostic cerebral angiography, 2nd edn. Lippincott Willims & Wilkins, Philadelphia, p 462

    Google Scholar 

  6. Tay KY, U-King-Im JM, Trivedi RA et al (2005) Imaging the vertebral artery. Eur Radiol 15(7):1329–1343. doi:10.1007/s00330-005-2679-z

    Article  PubMed  Google Scholar 

  7. Go AS, Mozaffarian D, Roger VL et al (2013) Executive summary: heart disease and stroke statistics – 2013 update: a report from the american heart association. Circulation 127(1):143–152. doi:10.1161/CIR.0b013e318282ab8f

    Article  PubMed  Google Scholar 

  8. Osborn AG (1994) Diagnostic neuroradiology. Mosby, St. Louis, p 936

    Google Scholar 

  9. Kaufman JA, Lee MJ (2004) Vascular and interventional radiology: the requisites. Mosby, Philadelphia, p 705

    Google Scholar 

  10. Ferguson GG, Eliasziw M, Barr HW et al (1999) The north american symptomatic carotid endarterectomy trial: surgical results in 1415 patients. Stroke 30(9):1751–1758

    Article  CAS  PubMed  Google Scholar 

  11. Vilela P, Goulao A (2005) Ischemic stroke: carotid and vertebral artery disease. Eur Radiol 15(3):427–433. doi:10.1007/s00330-004-2632-6

    Article  CAS  PubMed  Google Scholar 

  12. Stayman A, Nogueira RG, Gupta R (2013) Diagnosis and management of vertebrobasilar insufficiency. Curr Treat Options Cardiovasc Med 15(2):240–251. doi:10.1007/s11936-013-0228-7

    Article  PubMed  Google Scholar 

  13. Arnold M, Bousser MG, Fahrni G et al (2006) Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 37(10):2499–2503. doi:10.1161/01.STR.0000240493.88473.39

    Article  PubMed  Google Scholar 

  14. Schievink WI, Roiter V (2005) Epidemiology of cervical artery dissection. Front Neurol Neurosci 20:12–15. doi:10.1159/000088125

    Article  PubMed  Google Scholar 

  15. Kristensen B, Malm J, Carlberg B et al (1997) Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern sweden. Stroke 28(9):1702–1709

    Article  CAS  PubMed  Google Scholar 

  16. Gottesman RF, Sharma P, Robinson KA et al (2012) Clinical characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist 18(5):245–254. doi:10.1097/NRL.0b013e31826754e1

    Article  PubMed Central  PubMed  Google Scholar 

  17. Schievink WI (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344(12):898–906. doi:10.1056/NEJM200103223441206

    Article  CAS  PubMed  Google Scholar 

  18. Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M (2008) Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Radiographics 28(6):1711–1728. doi:10.1148/rg.286085512

    Article  PubMed  Google Scholar 

  19. Gottesman RF, Sharma P, Robinson KA et al (2012) Imaging characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist 18(5):255–260. doi:10.1097/NRL.0b013e3182675511

    Article  PubMed Central  PubMed  Google Scholar 

  20. Shin JH, Suh DC, Choi CG, Leei HK (2000) Vertebral artery dissection: spectrum of imaging findings with emphasis on angiography and correlation with clinical presentation. Radiographics 20(6):1687–1696

    Article  CAS  PubMed  Google Scholar 

  21. Chen CJ, Tseng YC, Lee TH, Hsu HL, See LC (2004) Multisection CT angiography compared with catheter angiography in diagnosing vertebral artery dissection. AJNR Am J Neuroradiol 25(5):769–774

    PubMed  Google Scholar 

  22. Bartels E, Flugel KA (1996) Evaluation of extracranial vertebral artery dissection with duplex color-flow imaging. Stroke 27(2):290–295

    Article  CAS  PubMed  Google Scholar 

  23. Sturzenegger M, Mattle HP, Rivoir A, Baumgartner RW (1995) Ultrasound findings in carotid artery dissection: analysis of 43 patients. Neurology 45(4):691–698

    Article  CAS  PubMed  Google Scholar 

  24. Leclerc X, Godefroy O, Salhi A, Lucas C, Leys D, Pruvo JP (1996) Helical CT for the diagnosis of extracranial internal carotid artery dissection. Stroke 27(3):461–466

    Article  CAS  PubMed  Google Scholar 

  25. Levy C, Laissy JP, Raveau V et al (1994) Carotid and vertebral artery dissections: three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography. Radiology 190(1):97–103

    Article  CAS  PubMed  Google Scholar 

  26. Mascalchi M, Bianchi MC, Mangiafico S et al (1997) MRI and MR angiography of vertebral artery dissection. Neuroradiology 39(5):329–340

    Article  CAS  PubMed  Google Scholar 

  27. Houser OW, Mokri B, Sundt TM Jr, Baker HL Jr, Reese DF (1984) Spontaneous cervical cephalic arterial dissection and its residuum: angiographic spectrum. AJNR Am J Neuroradiol 5(1):27–34

    CAS  PubMed  Google Scholar 

  28. Dittrich R, Nassenstein I, Bachmann R et al (2007) Polyarterial clustered recurrence of cervical artery dissection seems to be the rule. Neurology 69(2):180–186. doi:10.1212/01.wnl.0000265595.50915.1e

    Article  CAS  PubMed  Google Scholar 

  29. Reivich M, Holling HE, Roberts B, Toole JF (1961) Reversal of blood flow through the vertebral artery and its effect on cerebral circulation. N Engl J Med 265:878–885. doi:10.1056/NEJM196111022651804

    Article  CAS  PubMed  Google Scholar 

  30. Fields WS, Lemak NA (1972) Joint study of extracranial arterial occlusion. VII. subclavian steal – a review of 168 cases. JAMA 222(9):1139–1143

    Article  CAS  PubMed  Google Scholar 

  31. Gosselin C, Walker PM (1996) Subclavian steal syndrome: existence, clinical features, diagnosis and management. Semin Vasc Surg 9(2):93–97

    CAS  PubMed  Google Scholar 

  32. Herring M (1977) The subclavian steal syndrome: a review. Am Surg 43(4):220–228

    CAS  PubMed  Google Scholar 

  33. Osiro S, Zurada A, Gielecki J, Shoja MM, Tubbs RS, Loukas M (2012) A review of subclavian steal syndrome with clinical correlation. Med Sci Monit 18(5):RA57–RA63

    Article  PubMed Central  PubMed  Google Scholar 

  34. Tan TY, Schminke U, Lien LM, Tegeler CH (2002) Subclavian steal syndrome: can the blood pressure difference between arms predict the severity of steal? J Neuroimaging 12(2):131–135

    Article  PubMed  Google Scholar 

  35. Labropoulos N, Nandivada P, Bekelis K (2010) Prevalence and impact of the subclavian steal syndrome. Ann Surg 252(1):166–170. doi:10.1097/SLA.0b013e3181e3375a

    Article  PubMed  Google Scholar 

  36. Kliewer MA, Hertzberg BS, Kim DH, Bowie JD, Courneya DL, Carroll BA (2000) Vertebral artery doppler waveform changes indicating subclavian steal physiology. AJR Am J Roentgenol 174(3):815–819. doi:10.2214/ajr.174.3.1740815

    Article  CAS  PubMed  Google Scholar 

  37. Vecera J, Vojtisek P, Varvarovsky I, Lojik M, Masova K, Kvasnicka J (2010) Non-invasive diagnosis of coronary-subclavian steal: role of the doppler ultrasound. Eur J Echocardiogr 11(9):E34. doi:10.1093/ejechocard/jeq068

    Article  CAS  PubMed  Google Scholar 

  38. Buckenham TM, Wright IA (2004) Ultrasound of the extracranial vertebral artery. Br J Radiol 77(913):15–20

    Article  CAS  PubMed  Google Scholar 

  39. Flynn PD, Delany DJ, Gray HH (1993) Magnetic resonance angiography in subclavian steal syndrome. Br Heart J 70(2):193–194

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  40. Van Grimberge F, Dymarkowski S, Budts W, Bogaert J (2000) Role of magnetic resonance in the diagnosis of subclavian steal syndrome. J Magn Reson Imaging 12(2):339–342

    Article  PubMed  Google Scholar 

  41. Virmani R, Carroll TJ, Hung J, Hopkins J, Diniz L, Carr J (2008) Diagnosis of subclavian steal syndrome using dynamic time-resolved magnetic resonance angiography: a technical note. Magn Reson Imaging 26(2):287–292. doi:10.1016/j.mri.2007.05.005

    Article  PubMed  Google Scholar 

  42. Akin K, Kosehan D, Kirbas I, Yildirim M, Koktener A (2011) Diagnosis and percutaneous treatment of partial subclavian steal: doppler ultrasonography and phase contrast magnetic resonance angiography findings and a brief review of the literature. Jpn J Radiol 29(3):207–211. doi:10.1007/s11604-010-0521-2

    Article  PubMed  Google Scholar 

  43. Olsen KG, Lund C (2006) Subclavian steal syndrome. Tidsskr Nor Laegeforen 126(24):3259–3262

    PubMed  Google Scholar 

  44. Qi L, Gu Y, Zhang J et al (2010) Surgical treatment of subclavian artery occlusion. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 24(9):1030–1032

    PubMed  Google Scholar 

  45. De Vries JP, Jager LC, Van den Berg JC et al (2005) Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long-term results. J Vasc Surg 41(1):19–23. doi:10.1016/j.jvs.2004.09.030

    Article  PubMed  Google Scholar 

  46. Palchik E, Bakken AM, Wolford HY, Saad WE, Davies MG (2008) Subclavian artery revascularization: an outcome analysis based on mode of therapy and presenting symptoms. Ann Vasc Surg 22(1):70–78. doi:10.1016/j.avsg.2007.07.020

    Article  PubMed  Google Scholar 

  47. Song L, Zhang J, Li J et al (2012) Endovascular stenting vs. extrathoracic surgical bypass for symptomatic subclavian steal syndrome. J Endovasc Ther 19(1):44–51. doi:10.1583/11-3692.1

    Article  PubMed  Google Scholar 

  48. Sorensen BF (1978) Bow hunter’s stroke. Neurosurgery 2(3):259–261

    Article  CAS  PubMed  Google Scholar 

  49. Kuether TA, Nesbit GM, Clark WM, Barnwell SL (1997) Rotational vertebral artery occlusion: a mechanism of vertebrobasilar insufficiency. Neurosurgery 41(2):427–432, discussion 432-3

    Article  CAS  PubMed  Google Scholar 

  50. Netuka D, Benes V, Mikulik R, Kuba R (2005) Symptomatic rotational occlusion of the vertebral artery – case report and review of the literature. Zentralbl Neurochir 66(4):217–222. doi:10.1055/s-2005-836600

    Article  CAS  PubMed  Google Scholar 

  51. Horowitz M, Jovin T, Balzar J, Welch W, Kassam A (2002) Bow hunter’s syndrome in the setting of contralateral vertebral artery stenosis: evaluation and treatment options. Spine (Phila Pa 1976) 27(23):E495–E498. doi:10.1097/01.BRS.0000035308.10464.37

    Article  Google Scholar 

  52. Darkhabani MZ, Thompson MC, Lazzaro MA, Taqi MA, Zaidat OO (2012) Vertebral artery stenting for the treatment of bow hunter’s syndrome: report of 4 cases. J Stroke Cerebrovasc Dis 21(8):908.e1-908.e5. doi: 10.1016/j.jstrokecerebrovasdis.2011.09.006

    Google Scholar 

  53. Velat GJ, Reavey-Cantwell JF, Ulm AJ, Lewis SB (2006) Intraoperative dynamic angiography to detect resolution of bow hunter’s syndrome: technical case report. Surg Neurol 66(4):420–423; discussion 423. doi: 10.1016/j.surneu.2006.03.040

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Max Wintermark .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Science+Business Media New York

About this entry

Cite this entry

Chiao, D., Wintermark, M. (2016). Imaging of the Pathology of the Vertebral Arteries. In: Saba, L., Raz, E. (eds) Neurovascular Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9029-6_17

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-9029-6_17

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-9028-9

  • Online ISBN: 978-1-4614-9029-6

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics